What is it about ?
This patient guide deals only with nipple discharge and inflammation of the mammary gland in women who are not breastfeeding.
By “nipple discharge” is meant a leakage of milky (green, brown, yellow), watery or bloody liquid from the nipple.
The possible causes of a nipple discharge (galactorrhea) are various: infection, tumor, hormonal abnormality, chronic renal failure (1 in 4 women with chronic renal failure has a nipple discharge) or side effects of drugs (pill, metoclopramide, anti-inflammatory drugs). allergies and certain drugs used in the treatment of heart disease and psychiatric disorders).
The cause of inflammation of the glandular tissues of the breast (mastitis) is usually bacterial. The gateway for bacteria is usually a sore on the nipple (crevice or piercing). Some women have a dilation of a duct through which milk is brought to the nipple (milk duct) behind the nipple and in which fluid collects. This build-up can lead to inflammation.
Nipple discharge and mastitis can occur at the same time.
In whom and how often do they occur?
Galactorrhea mainly affects women between the ages of 30 and 50. The discharge of clear or white fluid from both breasts, caused by hormonal changes, is regular in women who have not yet gone through menopause.
Mastitis mainly affects women who are breastfeeding. It also affects women who do not breastfeed, but less often. It is more common among smokers. Milk ducts are more often dilated around menopause.
How to recognize them?
Galactorrhea is usually not accompanied by any complaints. At first, the only sign you notice is the presence of small stains in your bra. The discharge can occur from only one breast, or from both.
With mastitis, you may feel a hard plaque in your breast, and sometimes you may notice a red area that is swollen, painful, and warm to the touch. A nipple discharge is often added to this. A bacterial infection is often accompanied by slight bleeding from the nipple. General symptoms such as fever, chills and abnormal fatigue may also appear. If left untreated, mastitis can form an abscess. The hard plate then becomes more flexible and you feel the presence of liquid (pus) inside.
How is the diagnosis made?
Your doctor will first ask you questions about the exact nature of the symptoms, when and how they started, and will ask you what medications you are taking. He will carefully examine your breasts and see if the discharge is from one or both breasts. A blood test is also taken to measure the amount of the hormones prolactin (PRL, the main hormone that regulates milk production) and thyroid stimulating hormone (TSH, a hormone that stimulates the thyroid). This measurement allows, for example, to check if the nipple discharge is related to a hormonal problem. A single measurement of prolactin is not always reliable, as the hormone may increase transiently following palpation of the breasts and stress.
Most often, the doctor will also order an ultrasound of the breasts and a mammogram. Breast ultrasound is a painless exam. As for the mammogram, it is actually an x-ray of the breasts. Many women experience a painful sensation during this examination. In principle, it is best to schedule this test between your period and your expected ovulation date. This is when you get the best picture quality.
What can you do ?
It is always safer to have yourself checked out if you have a nipple discharge. If you have mastitis, get enough rest, drink enough, avoid tight clothing, and don’t wear a bra. Paracetamol or ibuprofen can relieve pain. Always consult your doctor.
What can your doctor do?
When faced with a nipple discharge, the doctor will always start by identifying and treating the underlying cause. If necessary, he will stop or replace the medicine that is causing the nipple discharge. If he suspects a hormonal abnormality or a tumor, he will refer you to a specialist.
Mastitis is treated with antibiotics. In the event of an abscess, you will be referred for surgical drainage. This drainage consists of opening the abscess, under anesthesia, in order to evacuate the pus. A drain is then placed to keep the wound open. This drain is replaced by the home nurse every day, until the abscess has completely healed.
Want to know more?
- Ultrasound here Where to find on this page of Cliniques St Luc UCL
- Mammography, here, Where to find on this page of Cliniques St Luc UCL
- Paracetamol – CBIP – Belgian Center for Pharmacotherapeutic Information
- Ibuprofen – CBIP – Belgian Center for Pharmacotherapeutic Information
- Percutaneous drainage, here, Where to find on this page of Cliniques St Luc UCL
Examples of drugs that can cause galactorrhea
- Antipsychotics – CBIP – Belgian Center for Pharmacotherapeutic Information
- Tricyclic antidepressants – CBIP – Belgian Center for Pharmacotherapeutic Information
- Opioids – CBIP – Belgian Center for Pharmacotherapeutic Information
- Oral contraceptives – CBIP – Belgian Center for Pharmacotherapeutic Information
- Metoclopramide – CBIP – Belgian Center for Pharmacotherapeutic Information
- Verapamil – CBIP – Belgian Center for Pharmacotherapeutic Information
- Isoniazid – CBIP – Belgian Center for Pharmacotherapeutic Information
- Antihistamines – CBIP – Belgian Center for Pharmacotherapeutic Information